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General NPI Number Information
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NPI Number | 1093080350
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Entity Type | Individual
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Provider Name | YVONNE GRACE RATTRAY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 15918 MEYER AVE
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City | JAMAICA
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State | NY
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Zip | 11433-3816
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Country | US
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Telephone | 718-866-5914
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Fax |
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Provider Business Mailing Address
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Address Line | 158-18 MEYER AVENUE
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City | JAMAICA
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State | NY
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Zip | 11433-4301
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Country | US
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Telephone | 718-323-2706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 017469-1
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License Number State | NY
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